Quantified Pathologic Response Assessed as Residual Tumor Burden Is a Predictor of Recurrence-Free Survival in Patients With Rectal Cancer Who Undergo Resection After Neoadjuvant Chemoradiotherapy

被引：45

作者：

Agarwal, Atin ^{[1
]}

Chang, George J. ^{[2
]}

Hu, Chung-Yuan ^{[2
]}

Taggart, Melissa ^{[3
]}

Rashid, Asif ^{[3
]}

Park, In J. ^{[2
]}

You, Y. Nancy ^{[2
]}

Das, Prajnan ^{[4
]}

Krishnan, Sunil ^{[4
]}

Crane, Christopher H. ^{[4
]}

Rodriguez-Bigas, Miguel ^{[2
]}

Skibber, John ^{[2
]}

Ellis, Lee ^{[2
,5
]}

Eng, Cathy ^{[6
]}

Kopetz, Scott ^{[6
]}

Maru, Dipen M. ^{[3
]}

机构：

[1] Baylor Coll Med, Dept Pathol, Houston, TX 77030 USA

[2] Univ Texas MD Anderson Canc Ctr, Dept Surg Oncol, Houston, TX 77030 USA

[3] Univ Texas MD Anderson Canc Ctr, Dept Pathol, Houston, TX 77030 USA

[4] Univ Texas MD Anderson Canc Ctr, Dept Radiat Oncol, Houston, TX 77030 USA

[5] Univ Texas MD Anderson Canc Ctr, Dept Canc Biol, Houston, TX 77030 USA

[6] Univ Texas MD Anderson Canc Ctr, Dept Gastrointestinal Med Oncol, Houston, TX 77030 USA

来源：

CANCER | 2013年 / 119卷 / 24期

基金：

美国国家卫生研究院;

关键词：

neoadjuvant therapy; pathologic response; near-complete; complete; preoperative; chemoradiation; recurrence-free survival; rectum; cancer; adenocarcinoma; PREOPERATIVE CHEMORADIOTHERAPY; PROGNOSTIC-SIGNIFICANCE; ESOPHAGEAL-CARCINOMA; BREAST-CANCER; NODAL-STATUS; CHEMOTHERAPY; RADIOTHERAPY; REGRESSION; CHEMORADIATION; RADIOCHEMOTHERAPY;

D O I：

10.1002/cncr.28331

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

BACKGROUND: The current study was conducted to determine whether quantified pathologic response assessed as a percentage of residual tumor cells is predictive of recurrence-free survival (RFS) in patients with rectal cancer. METHODSThe authors studied 251 patients with rectal adenocarcinoma who were treated with neoadjuvant chemoradiation and radical resection. Quantified pathologic response was defined as an estimated percentage of residual cancer cells in relation to the tumor bed: complete, no residual cancer cells; near-complete,5% residual cancer cells; major,>5%, and<50% residual cancer cells; and minor,50% residual cancer cells. The reproducibility of quantified pathologic response between 2 pathologists was assessed using tumors from 55 randomly selected patients who did not demonstrate a complete response. RESULTSPathologic response was complete in 21% of patients, near-complete in 20% of patients, major in 37% of patients, and minor in 22% of patients. Nineteen percent of patients had ypT0N0 disease, 27% had ypT1-2N0 disease, 21% had ypT3-4N0 disease, and 33% had N+ disease. The 5-year RFS rates by category of quantified pathologic response were as follows: complete, 95%; near-complete, 88%; major, 69%; and minor, 61% (P<.001). Major and minor response, high histologic grade, and perineural invasion were found to be significant predictors of decreased RFS on multivariate analysis. The 5-year RFS rates for patients with ypT3-4 or N+ disease were better for those with a near-complete response (94%) compared with those with a major (64%) or minor (61%) response (P<.02). Moderate to substantial agreement was observed between the 2 pathologists (=0.72). CONCLUSIONSQuantified pathologic response is a predictor of RFS in patients with rectal adenocarcinoma and stratifies patients with high pathologic stage disease. Cancer 2013;119:4231-4241. (c) 2013 American Cancer Society.

引用

页码：4231 / 4241

页数：11